MEDICARE: ABDULLAH MUBARAK MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RT0003X	Transplant Hepatology Physician	M5390	TX
2	207RI0008X	Hepatology Physician	M5390	TX
3	207R00000X	Internal Medicine Physician	M5390	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336109925
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ABDULLAH MUBARAK MD

Provider Business Mailing Address
First Line	:	PO BOX 260993
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75026-0993
Country	:	US
Telephone Number	:	469-317-7703
Fax Number	:	469-609-8033

Provider Business Practice Location Address
First Line	:	910 E HOUSTON ST STE 550
Second Line	:
City	:	TYLER
State	:	TX
Zip	:	75702-8366
Country	:	US
Telephone Number	:	903-606-8718
Fax Number	:	903-606-1218

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/27/2006
Last Update Date	:	05/21/2026

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